Page 122 - Journal of Special Operations Medicine - Spring 2016

CASEVAC aircraft (and surveyed landing zones) capable decision to change the manning document for the teams
of spanning the vast distances of the AOR, the ability of in October 2015. This change in manning and arma-
the teams to respond to casualties was degraded, espe- ment replaced the three-person ECCT with a TCCET, a
cially when engaged in remote DS during split opera- team consisting of an emergency physician, anesthetist,
tions. The widely dispersed threat to US forces across and a critical care or emergency nurse whose training
the AOR combined with the dynamic operational mis- and equipping enhanced the ability to provide en route
sion of US SOF in Africa prohibited a singular, fixed damage-control resuscitation for unregulated, prehospi-
model of deployment for the MFST and ECCT. tal patients.

The MFST and ECCT, though conceived and deployed to Clinical Operations
be capable of forward staging with man-portable equip- Though trained, equipped, and located far forward to
ment and to effectively conduct damage control surgery perform lifesaving, timely surgery and resuscitation, the
and resuscitation with eight providers, were found to MFST and ECCT performed no surgery on US Soldiers
make too large a footprint during some missions in Af- during operations by SOCFWD-NWA in the first year
rica. Faced with the challenge of limited billeting and life of operations. To maintain currency, the MFST and
support in far-forward desert ODA camps, the MFST ECCT became credentialed and developed a partnership
pared down to a three-person team on missions requir- with two hospitals in the theater: the CURE hospital in
ing a smaller footprint, while the remaining ECCT and Niamey, Niger, and the Role II hospital at the French
MFST members, far away from the three-person surgi- Headquarters for Operation Barkhane in N’Djamena,
cal team, continued to provide AS capability. The three- Chad. Operating on Nigerien and Chadian patients at
person surgical team consisted of a general surgeon, an these two hospitals in the theater enabled US SOF and
anesthetist, and an emergency physician, and deployed the French, Nigerien, and Chadian militaries in Africa
with 10 units of fresh frozen plasma, 10 units of packed to develop stronger relationships (Figure 3). By operat-
red blood cells, and equipment to perform one to two ing on more than 400 surgical patients in 12 months,
6
damage control surgeries. Relying on the 18D from the the MFST and ECCT maintained their critical care and
ODA and his team’s equipment, power, and shelter, the surgical skills while simultaneously assisting partner
three-person MFST forward deployed to be within 1 forces and host nations.
hour of casualties during high-risk operations.
On four occasions, the MFST and ECCT teamed with
As DS and AS requirements dictated, the manning and French Role II medical personnel during mass casualties
equipping of the surgical and critical care teams was flex- (Figure 4). In February 2015, during Operation Flint-
ible. DS at times consisted of an emergency physician, lock, the MFST and ECCT operated on multiple trauma
an emergency physician and an orthopedic surgeon, or patients in N’Djamena because of direct action between
the full MFST and ECCT. partner forces and Boko Haram. In June 2015, 29 casu-
alties were treated as a result of detonations by suicide-
The ECCT, though conceived and equipped originally vest-wearing members of Boko Haram in N’Djamena.
as ground support for casualties, began to fulfill the role The MFST, working with French Role II medics, treated
of an en route critical care and transport team. It was
most effective when colocated with CASEVAC aircraft Figure 3 An orthopedic surgeon from the MFST operating
with a French Military orthopedic surgeon on a Chadian
at the AOB where capabilities for holding and treating Boko Haram casualty in February 2015.
patients were robust. The ECCT could fly to the MFST
to provide post-DCS care or to the 18D to augment en
route care. By tailoring the teams to fit unique mission
requirements, the MFST and ECCT enhanced the medi-
cal capabilities in the AOR and provided surgical sup-
port and CASEVAC over a larger area.

The ECCT, by the end of the first team’s rotation, had
evolved predominantly into a CASEVAC platform. Be-
cause of the long distances for CASEVAC in SOCFWD-
NWA, the dissimilar vehicles involved, and the specialized
training required for en route critical care, a recom-
mendation by the deployed teams to replace the ECCT
with a Tactical Critical Care Evacuation Team (TCCET)
was made. The recommendation was endorsed by the
SOCAFRICA Surgeon General, resulting in the USAF’s

106 Journal of Special Operations Medicine Volume 16, Edition 1/Spring 2016